Rob Breakenridge: Sanctimonious Liberals have no business butting into Alberta health care

There have been some high-profile disagreements between Alberta and Ottawa in recent years over where provincial jurisdiction ends and federal jurisdiction begins.

The feds prevailed in the battle over the consumer carbon tax, while Alberta scored a major victory against parts of the Impact Assessment Act. The dispute over the Clean Electricity Regulations was rendered moot after the Carney government agreed to put that scheme on hold as part of the Alberta-Ottawa MOU.

And indeed that MOU seemed indicative of a new era of improved relations between Alberta and Ottawa that’s been building over the last eighteen months.

However, there is now a new battle brewing in a realm that is unambiguously provincial jurisdiction: health care.

The Alberta government is moving ahead with plans to allow certain physicians to practice in both the public and private health care systems. To participate, physicians would be required to work a minimum number of hours within the public system.

None of this will involve life-saving treatments, such as cancer surgeries. Nor does it involve family doctors. For now, the allowed procedures cover those already available at non-hospital surgical centres, such as cataract surgery, hip and knee replacements, and hernia repair.

This is all set to launch next month, although the specifics are still being hammered out around the number of hours doctors will be required to spend in the public system. The province says it will likely vary, based on region and specialty.

The jury is obviously still out on whether or to what extent this will improve health care delivery or outcomes in Alberta, and on whether Albertans are on board with this change. Premier Danielle Smith has been ambitious in her reforms and overhaul of health care, but Albertans don’t yet seem convinced that things are on the right track.

But ultimately it is Alberta voters that will judge all of this. Yes, it’s audacious, bold, controversial, unprecedented, or any number of other possible adjectives. One thing it’s not, however, is any of Ottawa’s business.

Nevertheless, the feds are making it their business. Federal Health Minister Majorie Michel has confirmed she fired off a letter to her Alberta counterpart conveying that she is “very concerned” about this plan and told the the Toronto Star she doesn’t “know how it can work within (the Canada Health Act).”

Premier Smith fired back this week, posting on social media that they “expect the federal government to respect Alberta’s jurisdiction and its authority to determine how health care is delivered.”

Smith also points out an important fact in all of this: “Alberta’s dual practice model does not violate the Canada Health Act. The Act does not prohibit private practice outside the publicly insured system.”

Now, it’s conceivable that a dual practice model could run afoul of the Canada Health Act. But the issue isn’t the existence of private health care providers, but rather the expectation that Canadians not be forced to pay out of pocket for insured medically necessary services. Smith maintains that “Albertans never have to pay out of pocket for medically necessary care.”

The Canada Health Act doesn’t erode provincial jurisdiction in this area, and it’s not some law of the land that mandates how provinces must deliver health care. Essentially, the Canada Health Act is the details of the strings-attached federal health care funding. If provinces want money for health care, Ottawa has its own conditions.

So, no, the feds can’t step in and block or veto Alberta’s reforms. The most Ottawa can do is withhold federal health transfers.

Putting aside the obvious national unity implications of such a move, it’s rather counterproductive to respond to concerns about access to health care by reducing overall health care funding.

As it stands, there is nothing that prohibits Alberta’s model as it’s currently structured. If there was, surely the federal minister would point it out, rather than resort to vague concerns and implied threats.

So what is the point of the letter? Despite the very clear lack of federal jurisdiction, the federal Liberals have long tried to portray themselves as the true defenders of Canadian health care through exactly this sort of political grandstanding.

That’s not to say Alberta has necessarily found the answer to fixing health care, but the difficult work of actually delivering care and convincing the public to accept changes to our broken status quo falls to provincial governments. Ottawa merely preaches from the sidelines.

There should be much more tolerance and flexibility in allowing provinces to experiment with alternative models of delivery. We’re so myopically focused on avoiding “American-style” health care, that we forget there are many other models and systems we could learn from or emulate.

Not everyone will be convinced, obviously. The irony though, is that by calling on the feds to intervene and shifting the underlying political dynamic, it will actually be harder to thwart Smith’s plans.

As noted, public opinion polls have not been favourable when it comes to the premier’s handling of health care. The governing United Conservative Party is on much steadier political ground when they’re taking on — or “standing up” to — Ottawa. They’d be much more comfortable if this turned into an Alberta vs. Ottawa fight.

The backlash to a financial penalty from Ottawa would be immediate and intense, especially with so much focus at the moment on how much Alberta contributes to Confederation. Furthermore, the idea that Alberta voters need to be protected from themselves would be another slap in the face.

This kind of federal intervention should be an absolute last resort; one which is not warranted here. If the federal health minister is inclined to worry about or watch closely what’s happening in Alberta, she’s free to do so. But spare us the sanctimonious letters and lectures.

The province’s voters are capable of holding the provincial government to account on a matter of provincial jurisdiction. Ottawa should butt out.

Rob Breakenridge is a Calgary-based podcaster and writer. He can be found at robbreakenridge.ca and reached at rob.breakenridge@gmail.com